Venous catheters, including central, peripheral, and so-called “midline” or extended-dwell peripheral venous catheters, are used in the medical environment to provide intravenous vascular access. Vascular access by venous catheters provides an expedient and highly effective means for drug administration, other fluid administration, chemotherapy, blood sampling, blood pressure monitoring, and parenteral nutrition, for example. These procedures often require that the catheter be left indwelling in the patient for an extended period of time. In a hospital setting, venous catheters are widely used in emergency departments, intensive care units, and operating rooms. In such settings, it is imperative that the venous catheters be very quickly and correctly positioned intravenously within the patient to obtain vascular access particularly in critical situations requiring rapid administration of medicines.
Highly effective and commonly used venous catheters are triple lumen catheters which are intravenously positioned within any venous structure, including the internal/external jugular, subclavian, or, femoral vein. Triple lumen catheters commonly include a central lumen which extends from the proximal end adjacent the user to the distal end which is positioned within the venous system. Two additional lumens may extend from the proximal end and terminate at a location adjacent to, but proximally removed from, the distal end of the catheter and terminate in open side ports. U.S. Pat. No. 7,311,697 B2 is an exemplary triple lumen catheter.
A widely accepted and commonly used percutaneous entry technique used to obtain access to the venous system of a patient requiring a venous catheter is a landmark guided technique known as the Seldinger technique. The Seldinger technique involves multiple steps which must be employed in medical conditions necessitating expedient placement of a line, such as in an emergency setting. In the Seldinger technique, the physician makes an oblique entry with a hollow needle through the patients skin, at a peripheral location using landmark guidance, and into a vein. The commonly used Seldinger technique is most often employed in combination with imaging guidance (e.g., ultrasound). Landmark guidance techniques involve visually or palpably locating anatomical landmarks for locating the targeted vein. For example, for subclavian vein entry, the landmark guided technique includes locating the junction of the middle and proximal third of the clavicle and inserting the needle at that location.
A blunt guidewire is then passed through the central lumen of the needle, and then the needle is withdrawn and removed leaving the guidewire within the vein. Next, a dilating device is passed over the guidewire to slightly enlarge the tract originally produced by the needle and, if warranted, multiple dilators having varying gauge, may be utilized, in a process called serial dilation. The dilator is then removed, leaving the guidewire within the vein. The catheter is then passed along the length and over the guidewire until positioned within the vein. Alternatively, use of a peel-away sheath may be used for placement of a catheter. The sheath may be utilized in conjunction with a dilator (also known as an introducer in this setting) for over-the-wire placement into the desired vessel. Once the sheath is within the vessel, the inner dilator (introducer) and wire are removed, allowing for placement of the catheter through the sheath's lumen. The sheath is then removed in a peel-away fashion, leaving only the catheter behind in the vessel. Blood may then be withdrawn from a catheter port to confirm the catheter placement within the vein. The guidewire is then removed from the vein.
With regard to initial percutaneous placement of the catheter, it is important to quickly position the venous catheter within the appropriate vein. This is imperative not only for the comfort of the patient, but also to achieve successful medical outcomes. Risks associated with incorrect catheter placement and multiple attempts at placement of the catheter include an increased risk of catheter related blood-stream infections from loss of sterility. In extreme instances, improper catheter placement may be injurious to adjacent structures such as the carotid artery, with serious consequences such as hemorrhage, stroke, or pseudo aneurysm formation. It is, thus, recognized that catheter placement may be assisted by utilizing real-time ultrasound imaging techniques in order to minimize such complications. Additionally, high quality, portable ultrasound units have become more regularly available to physicians, thereby further facilitating the use of ultrasound assisted venous catheter placement. An exemplary method employing ultrasound guided central venous catheter placement is U.S. Publication. No. WO 2014006403 A1. More recently, vascular access devices have expanded to include midline catheters, or extended dwell peripheral intravenous lines. Midline catheters are longer and more durable than traditional peripheral intravenous catheters. Different than central catheters, midline catheters do not terminate in the vena cava or right atrium. However, they are typically placed in the larger veins of the upper extremity such as the radial, cephalic, median, brachial or basilicvein. Owing to their durability and location, midline catheters can remain in place longer than the traditional 2-3 days for a peripheral intravenous catheter without the same risks of infiltration and infection. Additionally, because of their size and insertion location, midline catheters are inserted using a combination needle puncture and over-the-wire access and insertion procedure. Although this differs somewhat from the Seldinger technique used for central catheters, it lends itself to benefit from the design and procedure described herein.